The story "Homebirth Death: A Mother's Plea for Medical Backup,"in The Birthkit Issue 24 is a sad case. As a background to my comments, I mention that in the eight years when I practiced homebirths as a registered doctor, out of 1,190 bookings I had 106 postmature babies (more than forty-two weeks) of which three went to forty-eight weeks, a few more went to forty-six weeks, and lots went to forty-four weeks—and all those babies fared very well. I did lose one at forty-two weeks, which is not outside the obstetricians' limit.

Of those 106 postmature babies, only one fitted the textbook description of postmaturity, looking like a little wrinkled old man with stained skin, but that baby was extremely alert, and insisted on looking around the room instead of suckling.

What decided me to do no inductions for post-maturity was a very early mother in my homebirth series who refused induction despite my anxiety, went to forty-four and a half weeks and gave birth to a chubby pink, strong, healthy baby, with absolutely no sign of postmaturity.

If I had lost one of those 106 babies who went past forty-two weeks, obviously I would have done some deep soul-searching, but I doubt whether I would have changed my mind. Babies mature at different rates, not at exactly forty weeks, just as we adults do not become senile at seventy years.

Some might say I was lucky to deliver 106 postmature babies without losing one, but remember that my clients were mostly very health-conscious, especially regarding diet. None of them was driven to homebirth by financial difficulties—quite the reverse. In Australia it is far cheaper to birth your baby in hospital. I should also mention that I tend to disregard meconium as a supposed sign of foetal distress, because of other possible causes, for example, if the mother took laxatives.

Not having witnessed that tragic birth described in The Birthkit Issue 24, and without access to more comprehensive details of procedure, I cannot be dogmatic about the management. However, I have strong reservations about the move to flush out the meconium. I certainly would not have done that.

We are not told whether the water used was cold or warm. If it was cold, it would have stimulated baby's body, causing it to attempt to breathe and thus causing meconium aspiration. Anyway, we should not be looking for someone to blame, but rather attempting to console the inconsolable bereft mother.

I feel the advice from the midwives was always correct. I would not rely on ultrasound to establish dates. The best check, if the mother presents early enough, is that before ten weeks the foetal heart is more than 160, often 180, but by twelve weeks it usually settles to 144 or less.

But my present mood is—don't be fussy about dates. When you estimate the due date (I use 283 days, i.e. nine months and ten days, slightly more accurate
than the received forty weeks), also advise the prospective parents not to tell friends and relatives the precise date, but be vague, like "before the new year" or "before Thanksgiving," so that they will not be pestered by nervous well-wishers if they go past the "due" date.

Marion's response in The Birthkit Issue 25 is very good ["A CNM Discusses Postmaturity Syndrome"], but I must take issue with one sentence. She says "Postmaturity syndrome has recognized signs, and that's why the pediatrician who tried to resuscitate Barbaranne's baby knew it was forty-four weeks."

With the background of my experience with postmature babies, which is far more comprehensive than most other practitioners under the rule of induction at forty-two weeks or earlier, I have to assert categorically that the so-called recognized signs of postmaturity are fallacious because babies mature at different rates. Those signs are practically never due to real postmaturity, they are more likely to be due to other factors like a severe illness during pregnancy, or placental infarction well before term.

I knew that postmaturity signs were unreliable long before I ever started attending homebirths, because I can still remember the famous and respected paediatrician Kate Campbell telling us students about postmature babies having long hair and long fingernails and other signs, and premature babies having the reverse. But once I got into general practice and was delivering babies in hospital, I noticed that those signs were most
unreliable, and that some babies born before term had long fingernails and hair, and some babies born after term did not.

In any case I cannot share Marion's confidence that the paediatrician who tried to resuscitate the baby knew it was forty-four weeks, even though he said so. I know
paediatricians and obstetricians better than to trust a statement like that.

Dr. John Stevenson
Victoria, Australia